Last year I turned 40 years old, so a few months after my birthday I dutifully trudged to my local imaging center and began what I expected to be a yearly ritual – mammography, a somewhat uncomfortable screening for breast cancer.
Currently, the American Cancer Society, the American College of Obstetricians and Gynecologists, the National Cancer Institute and the American College of Radiology all recommend annual mammograms for women aged 40 years and older.
But that ritual may soon change for many women. Last week, a study published in the British Medical Journal cast serious doubts on the benefits of routine mammography.
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This 25-year study of 90,000 Canadian women showed no difference in death rates between women who had annual mammograms and those who had only clinical breast exams done by a skilled nurse. Further, the study also found that routine mammography often led to false positive results and over-treatment with surgery, radiation and chemotherapy.
This is not the first time in recent years that routine mammography has come under scrutiny. In 2009, the United States Preventive Services Task Force recommended screening mammograms every two years for women over age 50.
The USPSTF recommendations caused uproar among breast cancer advocacy groups, who felt the change in guidelines was more about saving money than saving lives. Some of these same groups are also questioning the validity of the new Canadian study.
I do not expect to see any sudden changes in clinical screening practices. It will take a while for the experts to sort through the research and agree on the best recommendations. But this new research should make women stop and think.
Maybe more screening isn’t best? Certainly the research has shown that for years we were over screening for cervical cancer, with too many Pap smears at too young an age.
If the breast cancer screening guidelines do change, it will not be an easy transition for clinicians or patients. I still have patients who demand annual Pap smears, despite me reviewing the rationale and research behind less frequent screening. I frequently encourage my patients to do their own research if they find themselves questioning why I recommend or do not recommend a particular test.
Unfortunately, in medicine there is often no clearly delineated right or wrong path. Using the best evidence available, along with a patient’s personal history and risk factors, may soon replace standardized testing to determine the most beneficial screening practices.
Patients and providers will have to weigh the risks and the benefits of mammography, and be more discerning when deciding how best to screen for breast cancer.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.
